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Counselors offer conventional wisdom to solitary, long term patients who are attached to them: “You have grown, and that growth will enable you to meet new and satisfying people.I’m merely the first person who understands and affirms you.I won’t be the last.”

I shared this with those whose attachment to me was substantial. Some doubted my words.Now, at a distance created by retirement, I’m less sure which of us was right.

For those who said I was wrong, I’m more than a little late in offering an affirming message in response to their concern.The belated acknowledgment is double-edged good news.The confirmation of your fear means you never found another person in your life who understood you enough, saw you clearly, and deemed you worthwhile.

Am I giving myself credit for insightful, redemptive compassion no one else duplicated?It is not as if I didn’t work hard to understand.It is not as if I didn’t recognize qualities that had gone long unseen and unappreciated.Many healers do this, however.I was not unique.

But, I was singular in several lives because I was their psychologist.

Clinician and patient encounter each other at a challenging juncture.The latter’s life is like a coin tossed above the crowd.Will it land heads or tails?If the therapist is a figurative fair wind, he tips the spinning silver for the better in an unrepeatable moment.

To the extent such an instant is a decisive one, perhaps the client will never meet another like him in a similar, poignant, and needful time.Whenever life is fraught after the treatment concludes, he might look back on past psychotherapy as an oasis worthy of an expensive return ticket.

Alternative paths exist.Not every person who enters counseling becomes so attached to the purported wise man sitting opposite him.Even among those who did bond before its conclusion, multiple people perhaps now provide more fulfillment than a therapist.Those relationships extend to meals together, bus rides, weekend evening plans, and physical intimacy.None of these occur in the patient/doctor range of interaction.

Nonetheless, the doc can be a hard act to follow for several reasons.

For a significant number, the healer made an indelible impact, perhaps an imprint.Remember what you learned about imprinting?Some birds and mammals will attach to another creature, not even of their species, who arrives during a critical, brief period:a moment fertile for bonding.

The right counselor at the right time with the right kind of intervention might be a bit like this.

Most patients — if they continue to work on themselves — will encounter new people who evoke as many positive emotions as the old psychotherapist.Still, these relationships are about both people, not so much about the client alone.

Trust develops in different ways inside and outside the clinic.Within the office, it is carefully orchestrated and permitted to be gradual.The room holds the possibility of becoming almost holy because faith (in another mortal, not a deity) enshrines the place.

In contrast, routine contact in the real world provides riskier opportunities to achieve confidence in another.The restaurant, workplace, and movie theater do not resemble sanctuaries. The ethical guardrails of the cloistered healing space are absent.

An impatient civilization puts down hurdles to closeness not everyone can overcome.Moreover, even best friends and mates do not hear all of the secrets some clients hide in the shadows.

Therapists do and, because they do, they double as confessors.They listen to the sins and inadequacies the client believes about himself.By bearing witness and accepting the reported frailties and flaws, the counselor frees him from the weight of the insecurity and doubt he carries.

Regardless of the wonders of a new friend or love, those companions cannot always be so focused on you as a person who gives professional guidance.This is true despite a weekly, clock-governed hour or two of purchased attention.

Indeed, the hour’s brevity and artificiality assists in creating the uniqueness and makes such focus possible.Where else in our busy, routinized adult experience does anyone get this?

There is a potential erotic quality present in the consulting room too, adding another level importance.Secrets are involved.Providers make appointments in advance, like a date.

The eager sufferer thinks ahead to these future engagements, considers what he wants to say, hopes to feel something soothing and enlivening.

Other competitors for the healer’s time exist (families, friends, spouses) as do additional “suitors” (other patients), and the troubled one worries about termination (aka getting dumped) just as we do in romance.

Experiences in the consulting room, as confined as they are by professional borders, remind us of impassioned events in our history.Perhaps the reminders come because we find ourselves talking about such past times and resurrecting dormant feelings.The memory of exposing one’s inner life to a psychologist lingers for many of those who allow this lowering of their defenses.

The ghost of the therapist might reside in the remembering mind as does a first love.Youthful friends, too, occupy a place in the heart to the end of many lifetimes.You passed with them through the same moment in history in the same place, experiencing like challenges and the same people in your shared world.

Wartime buddies, as well, understand things no one else fathoms.Nor should we forget the long-married, aged couples who are so molded to the other that they pass away close in time.

The sharing of something important, formative or reformative, is present in all these intimate contacts.

Intensity is a determinant in what can seem irreplaceable in such connections, whether with parents, childhood and adolescent friends, lovers, wartime comrades, and counselors.Similar ties are elusive.

I do not wish to understate the chance you will meet people who “get you” after you depart psychotherapy.Still, I now believe the possibility you may not is higher than I did before.

Each of us, no matter the losses we have had, must search to find new people who can become precious to us.Risks are required.The tightrope of homo sapien interaction offers no safety net, but we are a resilient species.

While many candidates for intimacy exist, if the task were comfortable, the patient would have been embraced by numerous such people before entering the mental health clinic.

Happiness is not a constant.Counselors do not erase the demands of living, including the filling of our social sphere.At their best, however, they empower you to identify and enhance the capabilities inside you to surmount them.

Even for those who profited from therapy and still lack fulfilling nearness, that satisfaction may yet occur.Our emotional lives never can be flash frozen.Children and grandchildren grow or move away and make their own families.Friends die or seek work elsewhere.Conflict with those we love is not always avoidable.

The cemetery is full of irreplaceable people who must be replaced.

Aristotle believed a person who did not require human connection was either a god or a beast. Thus, our quest for an essential other is a part of our nature.

You are not alone in your need to take on this challenge.

Many, many are looking.

They may be looking for you.

—–

The paintings reproduced above begin with Man with a Pipe by Joan Miró. It is followed by three works of Edvard Munch: Self-portrait in Bergen, Young Woman on the Beach, and Woman Looking in the Mirror. The final image is The Mask with the Little Flag by Paul Klee.

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33 thoughts on “Are Therapists Ever Really Irreplaceable?”

There is nothing like a therapist client relationship. And I don’t believe there is anything in life that will replace it. People are generally selfish and don’t care for others. Having that hour with my therapist is a bright spot in my life where I don’t feel judged and I am heard.

Beautifully written and articulated, Dr. S! In my current attempts at applying for an MS in Interdisciplinary Research, with my own thesis looking at trauma surviving populations that either no longer seek psychotherapy or have never sought psychotherapy and why (including trauma theories based on continuous traumatic stress and/or other forms of trauma heterogeneity), I read your blog post as one that looks specifically at a particular group of clients who, in fact, do seek psychotherapy and have had a truly good, effective, bonding experience with their therapist. Your blog post exemplifies what many clients seek in their relationship with their therapist, and what many clients who have experienced it are perhaps afraid of losing that kind of bond or relational exchange when treatment terminates. But your blog post also got me to wondering about other populations who avoid treatment altogether – either because they had not-so-good (or even abusive) therapeutic experiences in the past, or because their cultural practices and beliefs are such that they are able to feel understood and close to non-therapeutic (or holistically, naturally therapeutic) community members (including friends, family, and/or significant others). If Aristotle is correct, those who don’t seek treatment but also don’t seek bonding or other close ties with relational others, could be at risk for becoming a “beast,” or antisocial, or personality disordered, or a sufferer of loneliness. Alternatively, those who don’t seek treatment because they are highly resilient, hold many internal and external strengths, have post-traumatic growth, or have strong social capital may see treatment as unnecessary or may have found alternative treatment plans in the community – especially for those with high emotional and social intelligences. Those with low emotional and/or social intelligences, however, may need treatment – regardless of whether or not trauma had been experienced, or whether or not they meet the clinical range of a mental health diagnosis. But for many trauma survivors, it would seem that therapy and community support are needed – together. For those unlucky few who have trouble connecting with community members, the therapist seems to be, in their eyes, a role-fulfiller for both treatment and relational bonding. Perhaps the etiology of transference within the therapeutic alliance may include present-day challenges as well as past developmental problems – though I’m not sure, and I’ve not read much on that subject. However, it would appear that even if clients were to have strong community supports – either during treatment or after treatment had been terminated – the unique therapeutic bond with a really good therapist (like you, Dr. S) would be hard to replace, and may never be replaceable in the future. In my mind, replacing a really good therapist is tantamount to trying to replace a really loving pet that died or ran away; you can always get another pet (or therapist) and find a bonding experience with it (him/her), but it will never be the same. Like with each stage in life, as well as each relationship in life, people grow, change, move away, etc. If we were secure in our childhood relationships, or even in our adulthood relationships with family members who grow, change, pass on, but stay connected in one way or another, then we’d be secure in our adulthood relationships, too – by admiring what we had when we had it, mourning the loss with more love than negativity, and feeling connected in the world in such a way that we are sure we would find others to bond with similarly yet differently. If we were insecure in our childhood upbringing, however, our transference would ensue, as would our longing when we don’t get that closeness, the fear of termination when we do get that closeness, and the negativity that follows after a relationship rightfully needs to end for one reason or another. Despite my bad dealings with various therapists (and perhaps others like them), or my very stoic and/or short-term relationships with other therapists (and perhaps others like them), I have been able to appreciate the short bits of time that I was able to connect with therapists and others. I also appreciate the growing yet distal relationships I have with community support systems that have remained in my life for years or decades, despite their not being as close to me as a bonding therapeutic alliance or as a bosom buddy or as a loving family member – the latter three representing what I have lost and never regained. I think each person has to answer the question you presented in your title, and each person has to grow from that answer. But for what it is worth, therapists hold unique relationships that many people in society cannot fill – not even loving family members. It’s something that cannot be replaced, in my humble opinion. I think one can add different relationships in the future, including different therapists, but that uniquely good therapist can never be replaced in someone’s heart that values that relationship and all that it imparted. If anyone deserves veneration from their clients, I would imagine it would be you, Dr. S. Although I would never know what it would have been like to have you as my therapist, I can tell from your writings and responses to others that you were probably a really good one! I’m sure your clients would miss you so much, even if their lives are fulfilling after treatment.

Oops. I did not mean to imply that therapists are like pets, or that the attachment is like that with pets. Not sure if that was a Freudian slip, but I was just thinking of the unconditional love pets have for their human family and how it is hard to replace that.

Your praise is appreciated, glb. However much we encounter irreplaceable people, we don’t have much choice but to try to connect with those others who might carry similar interpersonal rewards or different ones. I take the inherent difficulties of life as a given, though they are not evenly distributed within the population. We must snatch our joy where we find it, if possible by focusing on the next 10 minutes and not waiting for some imagined future event (or person) which may or may not come.

I miss being a kid and hoping for a fairytale moment. Why do they invent cartoons like that, then, if it is not a realistic outcome for many? It is as if they want us to measure life in those terms, or at least dissociate our childhood away to escaping, pretending, and hoping.

Forgive my ignorance of psycho-therapeutic treatment, Dr. Stein, but is there a system of weaning a patient for eventual separation and independence?

I find your following comments of special interest: “An impatient civilization puts down hurdles to closeness not everyone can overcome. Moreover, even best friends and mates do not hear all of the secrets some clients hide in the shadows.” Perhaps, for those among us who are unable to let go of the unique relationship with a therapist, there should be a follow-up or concurrent treatment with another type of professional, one that would help the individual to find a place within their community.

Your comments are wise, Rosaliene. Yes, we try to wean them, but (again using the imprinting analogy), for some people it doesn’t “take.” I recall more than one patient in such a situation who, when I suggested a referral to another therapist, feared not only becoming attached again but also another iteration of the sense of loss when the counseling relationship with that person would inevitably end.

There are people in one’s life who truly are forever irreplaceable – the ones who mean the most, be they family, friend, or therapist, can never be replaced. Those irreplaceable ones in the cemetery will never be replaced, ever. You might find new people, different people to add to the “irreplaceable list”, but they will never be replacements for those most extra special people (or animals) no longer in your life, whatever the reason!

I take it you mean the irreplaceable ones are unique and therefore cannot, by definition, be replaced. No argument. But what we can do is find others who may have their own, different uniqueness. If we choose not to, the size of the hole in our lives drains the life in us in-perpetuity. In a sense, if we wish the best possible life available to us, we are forever trying to compensate for losses: loss of youth, loss of some of the physical talents of youth, loss of physical beauty, loss of time ahead, and loss of people. The danger of not doing so is to ensure one lives in a world of loss, rather than a life of engagement with the world and the possibilities remaining, no matter how grievous those losses are.

A great post! I can’t imagine my life without my therapist, but I know that time will eventually come. But for now this relationship is one I don’t take for granted. She’s my safe place in a chaotic and terrifying (yet beautiful) world. The therapist I had before her still has a huge place in my heart and won’t truly be “replaced” by anyone. Our hearts are big, so there’s place for others still. 🙂

Thanks for this very moving article Dr. Stein, and for keeping this blog on.

While not having the privilege to go to therapy myself, I could imagine that kind of healing relationship. One of your blog says the ultimate goal of therapy is “embracing life”, the real world outside the clinic. If I may ask, are there other paths that can lead to this ’embracing’ besides therapy? Is therapy really irreplaceable?

My habitual avoidance of real world and tendency to “live” in the abstract inner linguistic world are making up an empty real life that I feel anxious and unresolved about all the time(for not having a solid base of existence). I can analyze that I don’t “want” the real world, don’t want to go into it since I don’t believe there’s a good place for me or a person that would or want to care about me. I’m staying at a job that is not good for me for years, but I choose to continuously dig possible psychological reasons of why I don’t want my real world instead of actually looking for a new job. This guilt of avoiding life, of not ‘wanting’ life, of being hopeless about life (especially in the workforce area) while knowing “I should go out into the world”, is not serving me well, and yet I always avert my eyes from my real life problems by applying the only mechanism I’m used to—reading books and blogs, trying to find an ‘answer’, a cure to my inner problems. While a lot of insights do have values and shine some light on me, I still daily experience my self-alienation, my lack of courage of going to the outside world, my absence of the will to ‘want’ a real world life, and the consequential vicious circle and loneliness. How could this courage for embracing life come about?

I appreciate your blog and insightful articles very much. I’d be grateful if you could share your opinion on this.

You are most welcome, Danny. Given what you’ve described, therapy sounds like it might provide you with a transition from the intense internal life you’ve described and involvement with the external world to a greater and more satisfying degree. You sound very intelligent, so I imagine you have a value that some others, perhaps many others, would come to appreciate. While I don’t think anyone can provide another with “will,” you do seem to have a great interest in finding “an answer” and improving a life you’ve described as unsatisfactory to you. Good luck with this.

Thank you for your kind words Dr. Stein. You’re so right that I do have some kind of ‘will’ to change my condition even though the method is not efficient while I declare to myself that I have no ‘will’ for the world at all. The words we say to ourselves are so tricky that they often blind us!

If you are open to the idea, Danny, then a similar kind of exchange within a psychotherapy relationship might find you discovering more about yourself and more behavioral risks, in moderate steps, that you can take.

It is, of course, your life, Danny. One of the best questions therapists can ask is, “What is the cost of X,” with X being whatever choice or action or inaction you are discussing. There is always a cost, both of what we do and what we don’t do. No free lunch. We all make mistakes and if we have the time and are lucky we can retrace our steps and make new choices. Anyway, good luck with whatever you choose to do.

I have been mulling this article for the last 24 hours and I feel “unconditional positive regard” is the drug that lures a patient towards their therapist and holds them mentally, especially the ones who where disregarded in life. Unconditional positive regard is a must in order to build the therapeutic alliance but for the patient it is very intoxicating and causes them to feel as if they are unable to live without it. Therapists call it transference but maybe it is not as complicated as that, maybe it is really so simple for this feeling to be the heady response to unconditional positive regard. Reality is that it cannot be sustained in everyday life and the therapist who is so sweet and good natured, could be a bear out of the office. I believe if only the patient could catch a glimpse of that bear, they would return to reality and maybe the dependence upon the therapist would be diminished.

Unconditional positive regard or some approximation of it is certainly an important component. Yet therapists do not always deliver it, and still the attachment can become powerful. I’d also consider the fact that those with children have a significant period where the child is every bit as admiring of the parent, yet kids grow out of it, and the admiration is not quite the same thing as what a counselor provides. Now this bear will return to hibernation!.

I have no idea why this post makes me feel sad. I have never had a therapist in my past show me consistent unconditional positive regard. Most of my treatments were short-term before the discovery of my being “too complex.” I have grown to hate the word complex. I rarely bond with therapist, especially after having bonded with one in her bedroom. Bad trauma and retraumatization that had left me feeling triggered by therapy offices; it is like asking a rape victim to visit other people’s bedrooms and open up intimate details. Deapite my past, I still feel saddened by the idea of even mulling over replaceable and irreplaceable. We all die. We all move on after some growth or tragedy. We are never forever, at least not in this world. But that does not mean the same thing to me as replaceable. Sure, some can find new therapists to bond with. But none of each of those therapists are replaceable (lest they be the unethical ones, lol). I would rather see the legacies that are unique to the dynamic between one person and another that is memorable. Similar dynamics may come with others, but like snowflakes and fingerprints, the dynamics are never the same.

When I think of serial criminals pathologically chasing after similar dynamics and perhaps even keeping trophies as rewards and memories too empathetic for them to feel without a visual, I could imagine them going to the extremes of pathological replacing. Instead of mourning, they are criminally optimistic. I would never want to go to such extremes.

Or for narcissists who need their injuries constantly stroked, bandaged, and praised through their seemingly replaceable supply via noxious means – such is toxic for them and those who are hypnotized by them. They replace a lot for their own selfish gain, like the serial.

It helps me more to know that I can be authentic, and I can appreciate the authenticity of others, including healers. Authenticity can be found among healthy persons, but not among controlling and or unethical ones. What unconditional positive regard is is authenticity being allowed between two parties, not just one (the client). There is no replacing authenticity… In yourself or in others… There is only you being you and others being others, with differences between the two.

Bonding and attaching to those who allow you to be authentic are priceless memories. No two dynamics are the same. No two can be replaced in memory. More good dynamic experiences lead to more good and irreplaceable memories. We just learn to move on is all. But some losses are worth grieving in order to avoid treating the next like a rebound replacement.

No need to apologize, Dr. S. I just cannot think in terms of replaceable and irreplaceable regarding humans. I think more in terms of change, reconciliation, loss, gain, memory bank, experience, transformative relationships, temporal frameworks, risk, reward, give, take, and what one feels when engaging or walking away.

Do you reckon the Ben Sweetland saying: “we cannot hold a torch to light another’s path without brightening our own” is a truism in the therapeutic relationship? So the benefit of that very special relationship cuts both ways a little bit?

No question. Any therapist who does not grow in his humanity and knowledge by his interaction with the patient is ill-suited to the profession and much the worse in his ability to do any good. Thanks for commenting, LovingSummer.

Whether good research, desperation, or my projections, my first grasp for help landed in a strong grip. I did not really expect success or planned for a quick fix. Three years later I weekly visit the office of a therapist, mirror, parent, ally, mentor, friend, and life line that is on the edge of retirement. Every hint of separation brings tears to my eyes, yet I know this will be the way he fails me.

When the topic of departure surfaces, his version of “I was not unique” adds a different pain- something even more desperate, more painful than separation. If he is not unique, if this bond is not unique, then am I unique? Do I matter? Did our bond matter?

Thinking of this time together as such a fine alignment of forces that, by the very nature of the interaction and healing, prevents another repetition changes the loss. Indeed, I do not want to be the same person I was in that moment. In this image we can both be unique people at a unique time doing the best we can. And if that is the case then why should I not hope that I can find another – that, of course, will not be the same, but can still be close.

Perhaps with that hope the departure can hurt less. Perhaps it will help to savor what is now. Perhaps I can appreciate the miracle of the alignment and hold that for the journey ahead. Perhaps that will help when I cannot go back.

I’m touched by not only what you said but the way you said it, Rebecca. The sentiment of finding something one’s heart has forever sought is well-captured for me at the very end of a very old movie, the 1930s version of “Lost Horizon” starring Ronald Colman. It might resonate.

I never made it beyond six attempts at the mountain pass! And then only by train. What touched me in the movie’s closing dialogue was the eloquently expressed hope that we might, along with Robert Conway, all find our Shangri-La.

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In addition to psychology, you'll also find me musing on baseball, classical music, love, friendship, how we live, and how best to live. I'll tell a few stories and draw a few conclusions.
I hope that some tales will touch you and others help you to look at yourself and the world anew. Thanks for reading (and thinking) along with me! Your comments are most welcome.

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